Read an Excerpt
How to Look Hot in a Minivan
what i didn't expect after expecting
The 10 Terrible Things That Happen Postpartum
The morning after I gave birth to my first son, Will (the same morning I realized my stomach had morphed into something resembling a pool toy), I gathered the courage to step on the scale. Happily, I discovered that I'd already lost twenty-five of the thirty pounds I'd put on during pregnancy. Victory! Within weeks, I was still flabby, but I was back in my regular clothes (and, admittedly, feeling a little superior about that). Twenty-three months later, I delivered a second son, Tate--in the same hospital, no less--and I smugly hopped on the scale expecting the same results. I think I just assumed that I was one of those "lucky" women with good genes who would bounce back to my normal weight with little to no work. Unfortunately, I was not. I'd just had a six-pound, ten-ounce baby boy, but I was only seven pounds lighter than I'd been before giving birth.I actually stepped off and back on the scale at least four times, just to make sure it wasn't broken. It wasn't. I still had twenty-three pounds to go, and seemingly all of them were centered in the middle of my gut (every new mom knows the feeling; it's the perma-five-months-pregnant look). Losing the baby weight would prove much more difficult the second time around.
In fact, I was riding the New York City subway to work one morning, right around the time I came back from maternity leave, when an older gentleman repeatedly offered me his seat. I realized in horror that he thought I was still pregnant. And even though he was trying to be kind, the attempt at chivalry made me sort of hate him--not to mention feel absolutely ashamed of the way I looked. Not long after that, I was vacationing with my family when some bizarre woman approached me, told me she was "psychic," stared at my stomach, and asked if I was pregnant. (I wasn't.) After that, I was with my kids at a petting zoo when someone else asked me how far along I was. For seven long months, people would periodically ask if I was expecting and completely ruin my day in the process. (This is why I will never, ever ask a woman if she's pregnant--unless she's actually being wheeled into a maternity ward.)
One year after I gave birth, I hadn't lost all my baby weight. People were like, She's pregnant. And I was like, Nope--I'm just fat! I'm not one of those girls who can lose all that weight in six weeks, and, by the way, who are those people?
--Actress and mom Debra Messing
I remember waiting for some kind of miracle to happen, for my old metabolism to "kick in" or my hormones to straighten out--anything that would help rid me of that postnatal paunch. Despite the old adage that breastfeeding will help the pounds "melt away," the babyweight just wouldn't budge (and I nursed for fourteen whole months!). I even had my thyroid tested, more than half hoping I had some kind of legitimate health problem. It was enough to make me want to hide at home (not an option, unfortunately) or just give up altogether. I felt like I was teetering on the precipice of just letting it all go. Why even try when nothing seemed to work?
Sometimes I look at old pictures of myself and I think, Aaagh! I need to get that back.
--Reality star and mom Kendra Wilkinson on life after childbirth
Thankfully, I discovered that I wasn't alone--lots of women think they're prepared for the aftermath of pregnancy, but most are in for a really rude awakening. That abracadabra I'm-back-in-a-bikini tap dance that celebrities do, usually between three and six weeks postpartum, is just not in the cards for the average woman (and, of course, it completely distorts our expectations for ourselves).
"I think we're all a bit sheltered from the realities of life after childbirth," says New York OB-GYN Shari Brasner, M.D. "For example, if a woman has an abdomen that's incredibly scarred by stretch marks, she probably isn't showing it off in a bikini at the beach." New York dermatologist David Colbert, who counts celebrity moms Angelina Jolie and Naomi Watts as clients, agrees: "I've often said that we should have pre-pregnancy support groups, where we explain to women: This is what will happen to your body. Women need to be informed and prepared, because if you're not, it's like bungee jumping."
Well, I know I certainly bungee jumped into motherhood--and if you felt like crying because Skinnygirl Bethenny Frankel somehow managed to don her size 4 bathing suit just twenty-one days after giving birth, you probably bungee jumped, too. And let's be realistic: Somewhere along the way we all got tricked into thinking that no matter what we looked like before baby, we would bounce back looking like smoking-hot Jessica Alba. Not gonna happen. Most women are not rubber bands that just snap back in place after having a baby. In fact, your body--no matter how hard you work out or how many pounds you shed--will probably always look a little different after you give birth. Not worse, necessarily, but different. And it's important to understand all the ways your body likely has changed before you attempt to get back in your skinny jeans (and beat yourself up if you can't). Right off the bat, I thought it would be helpful to explain exactly what we're dealing with. So here's what can you expect ... after you've finished expecting.
1 Rapid and Sudden Hair Loss
Remember how gloriously thick your hair felt during pregnancy? Then, just a few months after giving birth--wham!--you're suddenly shedding like a sheepdog. It's not uncommon for new moms to develop a little halo of "baby hairs" around the forehead and the hairline or to feel as though they're losing more hair than normal. For months after I gave birth, I would torture myself in the shower, counting just how many hairs had fallen out into my hands, calculating how long I had left before the inevitable baldness set in. And I wasn't the only one who noticed: Once, I was getting made up for a TV appearance, when the makeup artist announced that he was going to dust dark brown eye shadow onto the part in my hair so that it would look "less wide." Horrifying.
So what's the deal with this sudden succession of bad hair days? Everybody sheds a little bit; in fact, typical hair loss is about one hundred strands per day. During pregnancy, however, elevated levels of estrogen in your body prolong the growth phase of the individual hairs, making them grow longer before they fall out. When your hormones eventually return to their pre-pregnancy levels, usually somewhere around four to six months postpartum, the normal hair loss cycle returns, too, in a process medically referred to as "telogen effluvium." "All those hairs that synchronized in the growth part of the cycle are now entering the loss phase together," says Dr. Brasner. That's when you'll start to feel as though you're suddenly going bald.
Though in most cases post-pregnancy hair loss will resolve on its own, it can sometimes be exacerbated by a thyroid condition, such as postpartum thyroiditis or severe postpartum iron-deficiency anemia (tests for both can be performed at your OB-GYN's office). In the meantime, you can help keep your hair healthy by using a conditioner and a detangler, rather than yanking at stubborn knots, and by not pulling your hair up in a high, tight ponytail (which can cause added strain at the hairline as well as additional breakage). "Since some of my patients want to be proactive while waiting for their hair growth to kick in," adds Dr. Brasner, "I sometimes prescribe iron supplements, even if their iron levels are relatively normal." If you feel that you're suffering from excessive hair loss, don't hesitate to speak with your doctor.
I used to have a near photographic memory. I could recite phone numbers without ever having to look them up, knew all my credit card numbers by heart, and had such detailed recall of events and conversations that more than one of my friends described my ability as "elephantine." Now, I seriously can't remember a thing. I create passwords for all my online accounts and mere moments later have no idea what I typed. Sometimes when I'm traveling for work, I actually have to stop and think about which airport I'm in. I even managed to leave my purse in the American Airlines lounge in New York once ... and didn't realize it until I had landed in California.
If having a baby has made you a little scatterbrained, you're not alone. Recent research suggests that "maternal amnesia"--with symptoms including, most commonly, an increase in forgetfulness, clumsiness, anxiety, stress, or the inability to concentrate--is a legitimate phenomenon among new mothers. (Though the prevalence of buzzing, vibrating devices and nonstop Internet access doesn't help. These days it's almost impossible to focus on one thing at a time. And it drives me crazy that any device that makes a beep or buzz--BlackBerrys, iPhones, etc.--somehow must be acknowledged by its owner, even in the middle of a conversation. Horrible.)
But don't let the term amnesia scare you--it's not as though you suddenly won't be able to recognize your own husband. However, according to a study published in the Journal of Clinical and Experimental Neuropsychology, performing new memory tasks, like learning a new phone number or remembering a new acquaintance's name (or recalling where in the world you put the pacifier that your baby wants right this minute), may prove slightly more difficult than before you got pregnant.
Researchers aren't sure what causes "mom brain," but it's thought that a variety of factors, including sleep deprivation, hormonal fluctuations, and the general upheaval that occurs when you bring baby home from the hospital, probably contribute to this phenomenon of forgetfulness. Also, symptoms may be present for up to one year after giving birth (though I think it probably lasts well beyond that), so while you're busy adjusting to your new role as a mom, you may want to actually start using the calendar on your iPhone or plastering your walls with Post-its. And try not to be too hard on yourself when and if you forget things. It happens.
3 The Mask of Pregnancy
It's not uncommon for pregnant women to develop a condition called "melasma," a form of hyperpigmentation (or discoloration of the skin) that most often appears on the upper lip, cheeks, and forehead. In fact, the American Academy of Dermatology reports that up to 70 percent of pregnant women will develop "the mask of pregnancy," as it's more commonly known. (And that 70 percent includes me--I had what looked like an ink spill on my forehead, as well as a darker patch on my upper lip that still shows up in just the slightest bit of sun. Unfortunately, it closely resembles Hitler's trademark mustache.)
Melasma is caused by a combination of sun exposure and an increase in the hormones estrogen and progesterone (which means that it can also show up on women who are taking birth control pills, since the oral contraceptive triggers an increase in those same hormones). While makeup tends to make the discoloration look worse (my husband once asked me with alarm, "What is on your face?" after I tried to cover it with foundation), it is possible for the spots to fade on their own after childbirth or when you stop taking the pill. Older, more stubborn patches may require a topical treatment, like a skin-lightening or retinoid cream or laser treatments (more on that in chapter 7). Meanwhile, protect your skin with a sunblock (not just sunscreen) containing zinc or titanium dioxide.
I thought, I'm just going to lose all the weight superfast because I'm going to breastfeed, and everybody tells you that if you breastfeed, it's going to come off like this. It's a lie!
--Actress and mom
4 Shrunken, Droopy, and Misshapen Breasts
If you think your breasts are smaller now than they were pre-pregnancy, they probably are. Many women experience a decrease in cup size around the time they finish breastfeeding. "I call this the 'shrivel up and disappear' phenomenon," says Dr. Brasner. "It's most common in women who are very thin, because they had very little fat in their breasts to begin with. But it's impossible to predict who will experience 'shrinkage.'"
So what causes this dreaded deflation? When progesterone and estrogen levels rise during pregnancy, all the inner structures of the breast glands increase, including the alveoli (where the milk is made and stored) and the ducts (the route the milk takes before passing out of the nipple). After delivery, however, that tissue starts to undergo some post-pregnancy "remodeling." In about 30 percent of cases, women will eventually see their breasts return to normal size. For the other 70 percent, oral contraceptives may prove helpful, since synthetic hormones often cause "the girls" to grow. Dr. Brasner also points out that your breasts will continue to grow and change with each subsequent pregnancy, so if you're not yet finished having children, there's still a chance that your bustline will bounce back all on its own. And if that doesn't work, well, you can always spring for a well-padded bra.
Speaking of bras, wearing a good one can actually reduce the likelihood that your boobs will one day relocate from your chest to your knees. "When your breasts enlarge during pregnancy and breastfeeding, that extra weight creates tension on and damage to the ligaments that support the breasts off the chest wall," says Dr. Brasner. That added strain could cause an irreversible sagging, not to mention unsightly stretch marks. "By wearing a supportive bra," Dr. Brasner explains, "you'll reduce the likelihood of permanently stretching out those ligaments." In other words, resist the urge to go all National Geographic, even when you're home alone with a nursing newborn.
I thought after you had the baby your tummy would just go down. I remember going, What's this deflated, wobbly thing?
--Actress and mom
5 Longer, Wider, and Weirder Nipples
It's no secret that breastfeeding will affect the size, shape, and appearance of the nipples (and any woman who has watched in horror as her nipple was stretched out to four inches when inserted in a breast pump probably assumed--correctly, as it turns out--that this outcome was inevitable). "The length of time dedicated to nursing can influence the changes, but most women will notice that their nipples have become wider, or more prominent, or both," says Dr. Brasner. Short of surgery, these changes are permanent.
6 Stretch Marks
"If you're going to stretch the skin of your abdomen for nine long months," warns dermatologist Dr. Colbert, "something is going to happen. Stretch marks are simply a rite of passage." That may be true, but stretch marks--which may appear anywhere you gain weight, in particular on your breasts, hips, thighs, butt, and, of course, stomach--are a major bummer.
Who gets stretch marks is determined largely by genetics, though studies estimate that anywhere from 50 to 90 percent of pregnant woman will develop these unsightly pink scars. "Supermodel Christy Turlington might never get a stretch mark in her whole life," explains Dr. Colbert, "while someone else might develop them just by having her skin gently tugged on. Most of us are somewhere in between." The good news is that stretch marks are somewhat treatable and will improve over time (we'll talk more about that in chapter 4).
7 Belly Bulge and Muffin Top
The recommended weight gain during pregnancy is around thirty pounds, and roughly eight pounds of that will be fat, most of which is deposited--perhaps not surprisingly--right in the middle of your gut. "It's the hardest fat to lose," says Dr. Brasner. "Most new mothers will feel as though they've thickened around the waist."
Compounding matters is a little-known--but almost universal--muscular injury that occurs during pregnancy. "Diastasis recti" is a separation of the two vertical bands of abdominal muscles that meet in your middle; normally, these muscles help to hold you in, but when theysplit, you wind up with that protruding "potbelly" look. In more extreme cases (typically after a multiples birth), diastasis recti can even cause your stomach pooch to resemble ...well, a derriere. Reality TV star Kate Gosselin, after delivering sextuplets, famously displayed her "butt in the front" on the hit show Jon and Kate Plus 8 and later underwent a tummy tuck to correct it.
"Almost 100 percent of pregnant women will get diastasis recti," says Dr. Brasner. "Unfortunately, there is little that can be done to prevent it." However, there are a number of exercises that may help you correct it. We'll go over those in greater detail in chapter 6.
Some women also will notice a little (or maybe large) pooch of fat in their lower abs, which has nothing to do with diastasis recti or even a swollen uterus (the uterus shrinks to its pre-pregnancy size within six weeks of delivery); if you can pinch more than an inch or so of skin on your lower abdomen, it's fat, plain and simple.
To fight that dreaded muffin top effect (that spillage of fat over the waistband of your pants), you're going to want to pack away your low-rise jeans, at least temporarily. Opt instead for a midrise pair, and don't be afraid to go up a size or two. "If you try to squeeze into too-tight jeans, the muffin top and back fat are only going to make you feel worse about yourself," says Sara Blakely, owner and creator of Spanx shapewear and mom to a toddler. "I went up two sizes in jeans after having my baby, and I'm just now getting back to my pre-pregnancy size."
8 Enlarged Vagina
Icky, but true: Almost all women who deliver vaginally will notice that their lady bits feel a little, ahem, stretched out after childbirth--even if there was no tearing or even after an episiotomy has completely healed. "The tissues of the vagina undergo a fair amount of trauma during delivery," warns Dr. Brasner, and in some cases, those changes may even affect sexual satisfaction when you resume having intercourse.
While some women may be tempted to resort to plastic surgery--in the last five years or so, "vaginal rejuvenation" has seemed to increase exponentially in popularity (at least anecdotally)--many doctors are strongly opposed to these types of controversial procedures. "Many surgical sites claim these operations will enhance your sex life," says Dr. Brasner, "but a healthy woman should be able to accept that these changes are normal and natural. I think doctors who offer these types of procedures are preying on women with low self-esteem."
A better (and certainly cheaper) option? Kegel exercises, which can help tone and tighten the muscles of the pelvic floor. To perform a Kegel, tighten and release the pelvic muscles--the same muscles that you would use to stop the flow of urine--and work up to doing three sets of ten per day. Keep in mind, however, that Kegels will not alter any exterior changes, which may include a larger vaginal opening and labia.
I read about these actresses who get on a stationary bike two weeks after giving birth and I'm like, What? Where did you push your baby out? Since having [daughter] Aviana, I have a muffin top, and that's okay.
--Actress and mom
the pee-pee problem
No, I am not talking about your child's issues, but rather your own. "Almost every woman who carries a term pregnancy, regardless of mode of delivery, will describe some change in bladder function after delivery," says Dr. Brasner. "I see this in my office all the time. It could be a change in urge, incontinence with cough or sneeze, or incontinence during activities." Sound familiar? I for one remember doing jumping jacks during a fitness class at the gym shortly after giving birth ... and then realizing that probably wasn't a great idea. All of these changes in bladder function are, of course, caused by a weakening of the pelvic floor supports, including soft tissues and ligaments, as a result of childbirth.
Dr. Brasner explains that full bladder function may not return while you're nursing (the tissues of the pelvic floor are very estrogen-dependent, but estrogen levels in your body remain suppressed when you're breastfeeding). Kegel exercises, however, can help some women regain some muscle strength and reduce symptoms. If problems persist, Dr. Brasner points out that there is a growing field of experts in urogynecology, where surgeons specialize in techniques to restore normal anatomy and function to the pelvic floor. And don't hesitate to ask your doctor about medication and alternative treatments (including biofeedback in some cases) that also may help improve incontinence.
9 Spider Veins
For some unlucky ladies, pregnancy may trigger a sudden outbreak of unsightly, visible veins (of all shapes and sizes) in the legs, the thighs, and even the pubic area. "Spider veins" (small veins, close to the skin's surface, that resemble spiderwebs or tree branches) as well as varicose veins, which are typically large, bulging, and ropy in appearance, are caused by changes in blood circulation that you may experience while expecting.
During pregnancy, the veins in your body begin to enlarge to accommodate an increase in blood flow. Additionally, the weight of your growing baby puts a decent amount of pressure on the vena cava vein--a major blood vessel that runs down the right side of your body. In fact, pregnant women--as you may know--are often encouraged to start sleeping on their left side (typically somewhere around sixteen weeks) to improve circulation as well as relieve the weight of the uterus on the vena cava; this may prove helpful if you're still struggling with varicose veins even after delivery.
Another common variation of vein swelling includes hemorrhoids, which are essentially varicose veins of the rectum. Thankfully, hemorrhoids brought on by pregnancy tend to disappear quickly. As for visible veins in the legs, about 50 percent of cases will subside once the baby is born, according to Dr. Colbert. To help the process along, try elevating your feet and ankles whenever possible and avoid sitting or standing for long periods of time.
I don't have a six-pack, but if I did, it'd mean I wasn't spending enough time with my kids. So I'm fine with it.
--Actress and mom of three Garcelle Beauvais-Nilon
10 Spreading Hips, Ribs, and Widening Feet
Even if you've lost the baby weight, you may notice that your clothes just don't fit like they used to. That's because many different body parts expand during pregnancy, and--sigh--sometimes they stay that way.
The culprit is the (appropriately named) hormone relaxin, which helps loosen or "relax" the ligaments so that your body can make room for baby. The most obvious place where expansion occurs is, of course, in the pelvic region--the bones slowly spread to make way for a growing fetus, as well as for his or her eventual delivery. (A new study actually shows that--whether you've had kids or not--your hips will continue to widen into your seventies, even as your other bones shrink. Hooray.) Additionally, the baby (and your uterus) occupies a lot of real estate right underneath the rib cage. Organs often get shoved northward, and as anyone who has ever been kicked in the ribs during pregnancy knows, it's a tight squeeze in there. Jennifer Lopez admitted that even though she got back down to her pre-pregnancy dress size, her rib cage was noticeably altered after having twins: "Before, I was always able to fit into samplesize clothes from designers, and now they have to let them out just a bit." (I've had my own issues with clothing; my breasts shrank, yet my ribs expanded, and nothing zips up like it used to. Bummer.)
Just like the hips and ribs, your feet may undergo some major changes during and after pregnancy. The twenty-six bones in each foot have to support a lot of extra weight, and they will often spread out in both width and length, thanks again to relaxin. In fact, doctors estimate that about half of all women will exit pregnancy with permanently larger feet than before. (Oddly, mine ended up a half size smaller, which no doctor ever seems to believe when I've mentioned it.) Anyway, it's a good idea to save any major shoe shopping until at least a month after delivery--give yourself some time to see where things settle.
I returned to work 25 pounds heavier than people are used to seeing me. There was nothing I could do about it. I just thought, I had a baby, that's way more important.
--Top Chef host and mom
why some moms bounce back faster than others
Research shows that the average postpartum weight retention is anywhere from one to six and a half pounds, though some studies put that number as high as ten to fifteen pounds. That means that if you have two children, you could easily wind up twenty pounds heavier than you were on your wedding day. And if you gain more than the recommended twenty-five to thirty pounds during pregnancy (and 36 percent of women do), that number could be even higher. However, the greatest indicator of your ability to shed the baby weight isn't how much you gained, it's the shape you were in before you got pregnant. So if you didn't look like Gisele Bündchen before you had kids, it's probably a safe bet that you aren't going to look like her afterward.
"I think that genetics as well as pre-pregnancy levels of fitness play the biggest roles in how quickly women bounce back," says Dr. Brasner. "In my experience, age isn't much of a factor." In other words, a woman who eats a sensible diet and is fit before getting pregnant is probably more likely to eat a sensible diet and be fit after delivery. How your own mother coped with her postpartum body also might be an indication of what you can expect in the future. "If a woman's mother was able to return to her pre-pregnancy weight and shape after each delivery," continues Dr. Brasner, "I find that ups the chances that my patient will do the same."
To increase the likelihood that you'll make it back into your skinny jeans, Dr. Brasner recommends trying to lose the baby weight within six months of delivery--especially if you're planning to have more children in the future. A woman who starts a second pregnancy at the same weight as her first pregnancy can typically expect to be able to drop the pounds again, while women who don't shed the weight between pregnancies will face a much bigger hurdle. "It really doesn't matter what the interval between pregnancies is," says Dr. Brasner, "it's the cumulative weight gains that really add up."
I can't ever get down to the weight I was before I had [first child] Honor. My body's just different. The jeans sort of zip up differently, and things hang differently. It's a miracle what happens, but you definitely are different afterward ... . Unless you're Gisele.
--Mom of two Jessica Alba
HOW TO LOOK HOT IN A MINIVAN. Copyright © 2012 by Janice Min. All rights reserved. . For information, address St. Martin's Press, 175 Fifth Avenue, New York, N.Y. 10010.